Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a multi-system illness
characterized, in part, by increased fatigue following minimal exertion, cognitive impairment,
poor recovery to physical and other stressors, in addition to other symptoms. Unlike healthy
subjects and other diseased populations who reproduce objective physiological measures
during repeat cardiopulmonary exercise tests (CPETs), ME/CFS patients have been reported
to fail to reproduce results in a second CPET performed one day after an initial CPET. If
confirmed, a disparity between a first and second CPET could serve to identify individuals
with ME/CFS, would be able to document their extent of disability, and could also provide a
physiological basis for prescribing physical activity as well as a metric of functional
impairment.

ME/CFS patients showed significant decreases from CPET1 to CPET2 in VO2peak (13.8%),
HRpeak (9 bpm), Ve peak (14.7%), and Work@peak (12.5%). Decreases in VT measures
included VO2@VT (15.8%), Ve@VT (7.4%), and Work@VT (21.3%). Peak RER was high
(≥1.1) and did not differ between tests, indicating maximum effort by participants during
both CPETs. If data from only a single CPET test is used, a standard classification of
functional impairment based on VO2peak or VO2@VT results in over-estimation of
functional ability for 50% of ME/CFS participants in this study.

Conclusion

ME/CFS participants were unable to reproduce most physiological measures at both maximal
and ventilatory threshold intensities during a CPET performed 24 hours after a prior maximal
exercise test. Our work confirms that repeated CPETs warrant consideration as a clinical
indicator for diagnosing ME/CFS. Furthermore, if based on only one CPET, functional
impairment classification will be mis-identified in many ME/CFS participants.

a disparity between a first and second CPET could serve to identify individuals
with ME/CFS, would be able to document their extent of disability, and could also provide a
physiological basis for prescribing physical activity as well as a metric of functional
impairment.

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Have I miss understood? Is that saying that due to this that physical activity should be prescribed? eg as in getting people to be more physical?? **confused**

What is meant by prescribing physical activity? shouldnt it say prescribe rest periods or something like that?

Have I miss understood? Is that saying that due to this that physical activity should be prescribed? eg as in getting people to be more physical?? **confused**

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Yes, I think they haven't learned enough about ME/CFS to realize a normal exercise program is counterproductive. I wouldn't worry about it, it is very good news that this study has been replicated, and they got the key points right.

This is the paper I have been waiting for! Thank you @Countrygirl . This is the independent confirmation of the CPET findings. No longer can anyone argue its one single group, now at the Workwell Foundation, who have made this finding.

@taniaaust1 , this kind of finding specifies what kind of exercise cannot be undertaken as well as what can. The current discussion at Workwell is about four year exercise programs, very slow, always staying within levels that do not exacerbate our energy production issues. It most specifically is against any form of graded aerobic exercise program.

Use of a single CPET only to indicate functional impairment in ME/CFS is problematic. The results of this study, and the consensus of the three previous studies of test-retest CPETs in ME-CFS patients, provide strong evidence of impaired physiological responses to exercise. More specifically, the abnormal post-exertional responses to exercise in ME/CFS are marked by test-retest decreases in VO2 and work at both maximum and ventilatory threshold intensities. Data from a single CPET resulted in classification of 12 of 22 patients as having little or no impairment, and eight as having mild/moderate impairment. Such individuals would likely be prescribed graded exercise therapy (GET) to improve aerobic capacity. However, data from the second CPET in this and prior studies [13,17,18] indicate that aerobic energy-producing processes fail to respond normally to exercise stress in ME/CFS patients. Thus, incautiously applied GET is likely to result in exacerbation of fatigue andother symptoms of ME/CFS patients.

Values for maximal RER of 1.17 and 1.14 that were reported in this study would be taken as an indication of strong, maximal efforts if reported in healthy subjects and athletes [49,50]. ME/CFS patients currently represent a unique class of ill patients who do not reproduce maximal CPET measures, unlike individuals with cardiovascular disease [27,30] lung disease [28], end-stage renal disease [26], pulmonary arterial hypertension [25] and cystic fibrosis [29].

This is the paper I have been waiting for! Thank you @Countrygirl . This is the independent confirmation of the CPET findings. No longer can anyone argue its one single group, now at the Workwell Foundation, who have made this finding.

What is meant by prescribing physical activity? shouldnt it say prescribe rest periods or something like that?

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The CPET results would show that limits need to be placed on exertion, and can be a scientific way to determine what those limitations are. Instead of "add a minute of walking every day even if you feel like cat puke", it can show that exceeding a certain heart rate, etc, must be avoided.

Hence it's more likely to result in pacing than GET, since it would indicate minimal activity on bad days where sitting up sends your heart rate to 150, etc. But the main difference is using a "physiological" basis to determine activity levels - our bodies would determine the limits, not some quack with a crazy theory.

It makes it possible to determine what really helps and what doesn't. CBT/GET nutters will not like this. They prefer things to be vague and opinion/authority based.

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It removes all opportunity for them to fabricate a mystical illness framework based on their unverifiable psychosomatic beliefs, and puts us back in the hands of science. The psychobabblers aren't the experts anymore, and anyone leaving them in charge should have a lot to answer for.

CBT/GET nutters will not like this. They prefer things to be vague and opinion/authority based.

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That is how it was all born.

The founder of the talking cure Sigmund Freud took loads of cocaine, felt invincible and started to tell stories about his talking "cures". Unfortunately people would believe him. Eventually this all became mainstream despite Freud being nuttier than a fruitcake. Once the idea of "curing" sick people just with brief, frequent talk sessions was in the mind of the public it became fact despite being fiction.

The modern cognitive approaches like cBS(Cognitive BS), while being different are based one the same 100 year old freudian ideas(or delusions) that sick people can be cured just with a little bit of talking.

Freud would make an inflation adjusted $500 per session and it is documented that he once told a wealthy patient in analysis that he had the subconscious desire to make Freud rich and asked him to donate to his psychoanalytic fund.

I read some of the cBS therapists in the UK earn $250 per hour selling their invisible snake oil. If it doesn't work they blame the patient or change the diagnosis and refer them to their buddies for further looting.

The true history of talk therapy is well documented in "The Freud Files". It's far worse than even most critics would admit.

Scientific’ psychology didn’t emerge as the fruit of a lucky discovery, a fortuitous invention, or by some ill-defined process of natural development. It was desired by its various promoters, and imagined on the model of the natural sciences.

One also has to remember that Freud was a blatant misogynist, with a serious "mother fixation" and never, ever forget that he was also a product of his time.
And that he had supportive buddies, such as Jung, who joined him in his coke-fuelled sessions...

Hmm, and his mad mate Fleiss who operated on women's noses because of his theory of 'nasal reflex neurosis', a supposed connection twixt nose and genitals. So Fleiss did nose operations to stop neurological and psychological 'symptoms, operations which had terrible physical results for the patients, notably Emma Eckstein, who was referred to Fleiss by Freud for nose surgery to cure premenstrual symptoms.

Freud is almost completely discredited. Richard Webster shows how he fabricated at least one of his cases. Yet, sadly, his legacy lives on in conversion disorder and other psychosomatic claims.

I have been of the opinion for some time that CPET is our big weapon in this fight. The test isn't perfect, its not an ideal diagnostic test of anything as severe patients may not be able to do it, but it shows the reality of things.

When things like this were discovered for gastric ulcers and MS it became only a matter of time before things changed. However I want to point out that, in peptic ulcers at least, it was active advocacy that really drove things along. I am unsure about advocacy involvement in the change of attitude to MS, but I think it would be a similar story.

The fuse is lit. The unproven hypotheses psychobabblers have been using are about to be demolished. Yet we also have a potential diagnostic test for the less sick, a treatment outcome biomarker, and a measurement of disability. Darn, somebody kick me, this can only happen in a dream.

Freud's legacy also lives on in the form of Freudian Feminist Literary criticism, most notoriously in the work of the shameless Elaine Showalter and her infamous book 'Hystories: Hysterical Epidemics and Modern Culture'.
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Freud's legacy also lives on in the form of Freudian Feminist Literary criticism, most notoriously in the work of the shameless Elaine Showalter and her infamous book 'Hystories: Hysterical Epidemics and Modern Culture'.
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At one time her book was one of the supposed "authoritative" sources that the Wikipedia page on CFS was using to support their line.

In case anyone is unaware, CPET technology, though not called that, goes back to at least 1949. That's a long time to miss something like this.

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It does seem like a really long time, doesn't it? I was thinking, well, but since we show normal on the first test, that's why it was dropped.

BUT if the doctors had TRULY listened to what the patients were saying? Then they would have been able to put two and two together to go - oh, but lets see if the person can function just as well on day two... after all, our worst episodes usually occurred after exertion.

I get missing it for a few years... but I think this is just another piece to prove that our symptoms were dismissed for far too long. I'm sure some doctors hear "I get really fatigued after excercising" and assume it's because we tried to do too much too fast.... and/or 'everyone gets tired after exercising'.... and didn't connect the dots that it's the extremeness of our reactions.

I'm just glad that it looks like a great way to finally get a diagnosis and will hopefully start shutting down all the people telling us it's psychological. Maybe then we'll finally get the funds pushed back into studying the diabling disease and see if we can't track down treatments/cures... I'd take anything not to keep getting worse.

Hi @PennyIA , you are stealing the blog I am writing! The finding about delayed recovery, and worsening etc., was only really obvious after the 1955 Royal Free Hospital epidemic. The Bruce Protocol popularized CPET from about 1963, so most docs should have known about it by about 1970, presuming they followed cardiac research for which it was developed. I still do not know when CPET went back to the original format, where things were measured rather than estimated. I suspect the 1980s. From that point on the medical profession can be considered to have resoundingly failed us.